Nursing home residents — who often deal with complex and overlapping medical conditions — should be included in more clinical trials for therapies and medications, a group of researchers is emphasizing more than ever.
They stressed the importance of building partnerships between long-term care providers and researchers so that both groups can improve care outcomes for patients in the long term and address the workforce challenges that keep many providers from committing to clinical trials in the short term.
Their work appeared recently in the Journal of the American Geriatrics Society, with the goal of spurring better patient care.
“I would hope that nursing home leaders would be motivated to participate in research because I think in partnership with researchers, we can get to solutions faster,” Kathleen Unroe, MD, a Regenstrief Institute research scientist, told McKnight’s Long-Term Care News Monday. “If we have the engagement and input up from, we will codesign better solutions.”
With partnerships on clinical trials currently lagging, new care methods for nursing home residents can be delayed, leading to continued adverse health outcomes even when solutions exist.
During the COVID-19 pandemic, for example, delivery of monoclonal antibody treatments that had been shown to reduce hospitalizations and mortality were delayed because nursing home residents had been overlooked in trials.
“It is imperative that we build the science of nursing home care around testing, prevention, diagnosis and treatment. It is a unique setting that merits more focus given the essential role it plays in the continuum of care for seriously ill adults,” said co-author Susan Hickman, PhD, director of the Regenstrief Institute’s Center for Aging Research.
Clinical trials could help streamline the process of gaining access to medications, therapies and vaccines, as well as processes for dealing with cognitive and behavioral health challenges, the researchers wrote.
Addressing justified hesitations
The authors recognized some real challenges that providers face when approached for collaboration on research trials. Overburdened staff and high employee turnover can make taking time to participate in a clinical trial a hard sell for providers.
“Providers should push researchers to explain the value of participation in the research project itself and get buy-in to the longer-term solution we’re trying to prove out,” Unroe said.
She mentioned that researchers are often willing to work with providers to address short-term challenges like staffing and funding. For example, researchers might be able to build compensation for processes like data collection into their grant budgets or send research assistants to complete those tasks rather than asking nursing home staff to do so.
“My big ask is to take the call,” she said. “Give us a chance to make the case for why it’s important, it’s relevant, it’s useful to both participate in this project and for the longer-term goal. And if you don’t like what you hear, give us a chance to fix that.”
At least one large regional provider has highlighted its success pairing residents with researchers. During COVID, Principle LTC partnered with Eli Lilly to offer access to a Phase 3 clinical trial of the drug Bamlanivimab, or BAM, during outbreaks. Principle President and CEO Lynn Hood said access to the drug helped save residents’ lives, and the provider created an ongoing program to participate in future testing.
Hood predicted the trial’s success in skilled nursing facilities would encourage drugmakers to partner more often with providers whose residents have complex medical needs, though researchers said Monday that huge gains haven’t yet been made.
The study’s authors called on researchers to proactively anticipate providers’ needs as well — building the needs of staff and residents into their plans as early as possible.
Despite the challenges, researchers and providers stand to benefit from more complete data and — in the long term — better health outcomes for residents, Unroe said.
Providers hoping to buy into an already-existing platform for collaboration with researchers should consider the The Long-Term Care Data Cooperative, the authors wrote. This platform currently connects more than 2,000 nursing homes, according to Unroe — centralizing and streamlining data and providing a network for providers hoping to be more involved in the process.
“The big thing is that we will get there faster if we work together,” she said.
